Kids and Weight: This one shift in our thinking could radically improve health for future generations
Being a parent is hard, usually unappreciated, work. Every day, especially when our kids are small, we have to make so many decisions on their behalf that will, in large part, determine many aspects of their lives. These decisions can both have an enormous impact on our children’s health and determine what our children think and feel about themselves.
Above all else, we all want our children to be healthy. But despite what we often take for granted as undisputed fact, it’s possible that we have lost sight of what “healthy” even means. Our culture – often referred to as “Diet Culture” – conflates health with thinness to such a degree that any body that does not fall into its narrow standards is subject to scrutiny, bullying, and shame; sometimes to a truly extreme and cruel degree. These stigmatizing behaviors, often enacted by the very healthcare professionals that are supposed to be primarily concerned with health, actually create worse health outcomes for our children.
Children who are subjected to weight stigma are often driven to disengage from healthy behaviors and learn to dread seeing doctors. Children in bigger bodies who are placed on restrictive diets, punishing exercise regimens, weight loss drugs, or even subjected to bariatric surgeries often end up gaining more weight in the long term, hating their bodies and starting down a path of long-term disordered and dysfunctional relationship to food and movement, including developing dangerous eating disorders. Making weight and body size our primary obsession makes us less physically, emotionally and mentally healthy, not more.
Luckily, there is a growing movement toward requesting weight neutrality from healthcare providers when it comes to caring for our children’s bodies and health. This movement has grown from 30 years of research that demonstrates: 1) healthy bodies come in all shapes and sizes; 2) thinness is not synonymous with health; and, 3) chronic dieting leads to worse health outcomes over time.
Almost all dieting becomes “chronic dieting” because 95-98% of diets fail to produce long-term weight loss. That is, in an effort to protect us from starvation and death, our bodies’ mechanisms fight against continued weight loss and the maintenance of a low weight for a body that is naturally meant to be at a higher weight. When we restrict calories and/or engage in extreme exercise without replenishing calories lost, we change our metabolic response. Our metabolisms actually slow down, hold on to calories and fat differently, and distribute weight in a way that will make it even harder to lose. So, most weight lost on diets is gained back, with interest.
It is an important feature of Diet Culture that when diets fail to produce long-term weight loss results we do not blame the diets but rather, we blame ourselves. In fact, our culture is set up around the assumption that if we don’t lose weight and keep it off, we are just not working hard enough. This is an overwhelming amount of pressure for a child or teen who is already experiencing the often overwhelming pressure of simply growing up. But the reality is that if a body wants to stay at a higher weight, it will do whatever it takes to stay at that higher weight which leads to the increasingly more and more accepted reality that healthy bodies come in all shapes and sizes.
This phenomenon of initially losing weight on a diet only to gain it all back, with interest, is often referred to as “yo-yo dieting” within Diet Culture. This term places the responsibility for the action and failure of the diet on the dieter rather than where it actually belongs. Many weight loss and weight stigma researchers, call this same phenomenon “weight cycling.” Weight cycling is dangerous and leads to an increased risk of heart disease, disordered eating, eating disorders, healthcare avoidance, body hatred, anxiety, and depression. Weight cycling is also incredibly common among folks who were deemed “obese” or “overweight” as children (Those of us who have accepted the fact of body diversity and who know that thinness and health are not the same thing, reject the pathologizing of bigger bodies with these O-words which is why I place them in quotation marks in this article). In fact, the earlier a child is started down the path of weight loss, the longer, more frequent and more extreme their weight cycling will be.
Armed with the new, extreme and misguided American Academy of Pediatrics’ clinical guidelines for treating children with “obesity,” your healthcare providers are likely doubling — and tripling — down on both their stigmatizing behavior toward… and weight loss recommendations for… your children in larger bodies. This brings us back to those decisions you have to make for your children that can both have an enormous impact on their health and what they think and feel about themselves for the rest of their lives. Healthcare providers can recommend — even strongly — interventions for our children in bigger bodies but the full responsibility of choosing to enact those interventions on our children rests with us, their parents.
Encouraging our children to live their healthiest lives possible is an important part of the job of parenting. It may be the most important part. This is precisely why divorcing the concept of health from thinness is so vitally important. Far more often than not, interventions to make kids in bigger bodies thinner results in worse health outcomes for the rest of their lives, not better. Focusing treatment for children in bigger bodies on weight is not healthy and does not lead to better overall health.
Indeed, focusing healthcare for adults in bigger bodies on weight is also not healthy and does not lead to better overall health. Unfortunately, in a weight and appearance-obsessed society, weight-centric care is the only thing on offer from most healthcare professionals. So much so, that most of us parents are caught in the same unhealthy beliefs and behaviors that we’d like to help our children avoid. We often hate our bodies and believe they are unacceptable. We are often dieting, chronically. We have dysfunctional relationships with food and movement. We may talk openly about hating our bodies in front of our children (which, in itself, is damaging to our children’s self esteem). The reality is that we cannot request weight neutral healthcare for our children unless we understand why we need it ourselves. But we, as parents, need to stop conflating health with thinness if we want to set our children up for the best possible health outcomes. And this is true no matter what types of bodies we and our children are living in because no body (no matter how thin) is safe from body shame in Diet Culture. The best chance our children have for a healthy future is for us to confront our own body shame and need for weight neutrality.
Weight neutral healthcare focuses on health rather than physical appearance and thinness. Rather than using weight as a marker of health, weight neutral healthcare asks more important, more nuanced questions around nourishment, movement, sleep, and relationship patterns. Weight neutral healthcare accepts the reality of weight stigma’s damaging effects on overall health and refuses to enact further weight stigma on its patients. Weight neutral healthcare is also hard to find, difficult to ask for, and completely outside of the traditional weight-centric approach taught to medical students.
There are glimmers of hope. A new group of passionate young medical students who call themselves Medical Students For Size Inclusivity are attempting to make change from inside the medical community by shifting the narrative away from Diet Culture and towards weight neutrality. Many therapists, health coaches, and dieticians are working to change the peripheral healthcare landscape by offering weight neutral care and programming. Some of these professionals can be found on the Association for Size Diversity and Health’s Health At Every Size Provider Listing. Many individuals and families benefit immensely from working with these professionals to simply unlearn all the damaging beliefs they have absorbed from Diet Culture. These professionals can also help families navigate weight-centric healthcare spaces and the decisions they will be forced to make regarding their children’s health.
To say “parenting is hard work” is an understatement. Often the job of parenting feels overwhelming and, for many parents, lonely. One of the reasons that weight-centric healthcare has lasted so long (since the 1950s) is that parents are exhausted and often need to rely on professionals who are supposed to be focused on their child’s health and best interests. In other words, we don’t question weight-centric healthcare providers. We are too tired and too overwhelmed and we assume they know what’s best. For this reason, it’s unfortunate that healthcare is an area where parents need to start taking back some agency and really questioning how steeped in Diet Culture their providers actually are. For a lot of parents, this just creates more work. But the shift to weight neutrality is essential for the well-being of our children — and their children. And future generations — and their health — are worth it.
JodiAnn Stevenson is a weight neutrality / weight stigma researcher currently working towards her doctoral degree at California Institute of Integral Studies. She also works as a weight neutral health coach and personal trainer to guide her clients toward healthier relationships with their bodies, food and movement.
